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Biomedical subjects

M Neary

Publications and source records attributed to M Neary.

At least 19 recordsLinked to original sources
PubMed2001

Responsive assessment: assessing student nurses' clinical competence.

This paper argues for a new approach to continuous assessment of students of nursing clinical competence, which I call responsive assessment. Its argument for this is based on a research study highlighting the problems and concerns students and practitioners identified in relation to the assessment of their nursing practice and clinical competence. It puts forward a case for challenging role boundaries by implementing contract assignments: as an integral part of adult learning and continuous assessment (Neary 1992a, 1998) and for developing a conceptual model called responsive assessment, in which the students' readiness for assessment and their response to patient/client needs is identified.The arguments are developed against the background of Benner's movement from novice to expert (Benner 1984) and Stake's (Stake 1977) three stages of antecedents, transaction and outcome as a process for professional students development.

Clinical Competence↗
PubMed2000

Supporting students' learning and professional development through the process of continuous assessment and mentorship.

This paper is based on the results of two studies carried out by the writer, over a period of 6 years (1991-1996), aimed to establish what happens in nursing practice in relation to assessing clinical competence of nursing students and the support they receive during their Nurse Education Programme. Study number one (1991-1995) was based upon the experiences and perceptions of 155 skilled practitioners and 300 students from three Colleges of Nursing and 45 interested practitioners, who volunteered to join the research at a later date because they were experienced assessors and mentors. Many themes and categories emerged. One in particular was that of the role of the practitioner who has been charged with the responsibility of assessing student performance on practice placement. Initial interviews with 155 practitioners of varying experience as assessors were used to design a questionnaire containing both context free and context specific items. Subsequent follow-up interviews were undertaken with both students and practitioners and non-participant observation of practitioners working with students were carried out. The majority of students accepted the dual role and at times, even the triple role of assessors, mentors and/or supervisors forced upon practitioners, provided that the practitioners assessing them were well prepared and 'trained' as assessors, were perceived to be 'fair', 'competent', 'skilful' and 'knowledgeable' (Neary 1997a). Study two (1992-1994) aimed to establish the process and outcomes of practitioner-teachers and mentorship in Wales, and was based on the data from a much extended period of semi-structured interviews with policy makers, managers, teachers and nurse practitioners (n = 360, 330 analyzed in detail) spanning 10 months, which gave an invaluable pictures of ongoing changes in the placement areas and the basis from which to construct a widely administered questionnaire (n = 1332) dealing with context-free and context-specific factors underpinning the definition of the mentor role, selection and relationship with students. Similar logic lay behind the use of reflective semi-structured diaries which asked 138 students and 133 practitioners to keep during practice placements. This study showed the practitioners readily adopted the term 'mentor' to describe their role in their relationship with students in clinical practice. How they were selected for this role proved to be more complex (Davies et al. 1994). for the purpose of this paper the data from both studies is merged to give a stronger and more focused picture of how both students and practitioners perceived their roles in the assessment and support systems which were in action at the time of the studies.

Attitude of Health Personnel↗
PubMed1999

Reduced resource utilization in patients treated for postoperative nausea and vomiting with dolasetron mesylate. MCPR44 Study Group.

STUDY OBJECTIVE: To compare the effect of four different increasing increasing intravenous (i.v.) doses of dolasetron mesylate (12.5 mg, 25 mg, 50 mg, and 100 mg) versus placebo on resource utilization in patients who experienced and were treated for postoperative nausea and vomiting (PONV). DESIGN: Prospective, double-blind, randomized, multicenter study. PATIENTS: 620 ASA physical status I, II, and III male and female outpatients scheduled for surgery with general anesthesia. INTERVENTIONS: Patients who experienced postoperative nausea (duration > or = 5 min, self-reported as moderate to severe) or vomiting (> or = 1 emetic episode) within 2 hours of arrival in the postanesthesia care unit (PACU) were given a single i.v. dose of dolasetron mesylate (12.5 mg, 25 mg, 50 mg, or 100 mg) or placebo infused for at least 30 seconds. MEASUREMENTS AND MAIN RESULTS: Resource utilization in the PACU was assessed by time spent by nurses and/or doctors with patients for PONV and the use of hospital resources such as patient/bed linens and staff/emesis supplies. A significantly (p < 0.05) lower proportion of dolasetron-treated patients compared to placebo-treated patients required new patient/bed linens and staff/emesis supplies. Patients in the placebo group required the greatest amount of care from nurses and/or doctors compared to patients receiving dolasetron. CONCLUSIONS: Treatment with dolasetron can significantly decrease the utilization of emesis supplies and other hospital resources, including staff/emesis supplies and patient/bed linens. In addition, patients receiving dolasetron used fewer health care resources in time spent by hospital personnel than patients who were not treated with dolasetron.

Adult↗
PubMed1997

Defining the role of assessors, mentors and supervisors: Part 2.

This is the second part of a study, carried out over four years, which examined what happens in nursing practice in relation to assessing the clinical competence of nursing students during their Common Foundation Programme (CFP). The study was based upon the experiences and perceptions of 155 skilled practitioners and 300 students. Many themes and categories emerged, including role overlap and lack of understanding of the role of the practitioner who has been charged with the responsibility of assessing student performance on practice placement during the CFP. Last week we reported the data on the skilled practitioners, and this week we look at the student and assessor data at the end of the project. Most students accepted the dual role and, at times, even the triple role of assessor, mentor and/or supervisor forced upon practitioners, provided that the practitioners assessing them were well prepared and 'trained' as assessors.

Attitude of Health Personnel↗
PubMed1997

Defining the role of assessors, mentors and supervisors: Part 1.

This study, carried out over a period of four years, aimed to establish what happens in nursing practice in relation to assessing clinical competence of nursing students during their Common Foundation Programme (CFP). The study was based upon the experiences and perceptions of 155 skilled practitioners and 300 students. Many themes and categories emerged, including role overlap and the lack of understanding of the role of the practitioner who is responsible for assessing student performance on practice placement during the CFP. This week we look at the data relating to the 155 skilled practitioners and next week we will review the student data and final data from the assessors, and make some recommendations for practice.

Clinical Competence↗
PubMed1997

Project 2000 students' survival kit: a return to the practical room (nursing skills laboratory).

The author's recent research study (Project 2000 assessment of clinical competence: an investigation) plus others (Jowett et al 1991, McEwen et al 1993, Davies et al 1994) have highlighted the Project 2000 students' need for a survival kit in the form of 'practical skills' before going to their allocated practice placements. Interviews at three colleges of nursing and midwifery with 70 students and 80 practitioners and data from 300 student questionnaires and 155 named practitioner questionnaires confirm that which has been echoed ever since Project 2000 began. Students have expressed anxieties and worry about their perceived lack of preparation by the college tutorial staff for practice placements. Their concerns fall into three main categories: (1) fear of doing the patients harm; (2) not belonging to the nursing/caring team; and (3) not being fully competent on registration. Students believe that if they are given the opportunities to practise nursing procedures and caring skills which they and nurse practitioners identify as 'basic nursing care' needed to care for patients without fear of endangering them and feel secure and provide a sense of belonging by being part of the caring team, irrespective of the length of the exposure to that client group and caring team, then their fears and insecurities will be alleviated.

Adaptation, Psychological↗
PubMed1997

Ovarian function after hysterectomy in an Irish hospital population.

A group of 52 women following hysterectomy with conservation of one or both ovaries was compared with an age-matched control group attending with menstrual irregularity/menorrhagia, in terms of proportions of women with postmenopausal endocrine profiles, and climacteric symptoms. The mean age for the groups was 42 years, and the mean interval between hysterectomy and the time of the study was 3.5 years. Endocrine levels were postmenopausal in six study and two control patients, and this difference was not significant. Vasomotor symptoms were a complaint of 28 (54%) of the study group and 18 (35%) of the control group, while 30 (58%) and 18 (35%) respectively had at least two other non-specific symptoms. In the absence of prospective studies elucidating the effect of hysterectomy on ovarian function, endocrine profiles should be performed in hysterectomised women complaining of symptoms.

Journal Article↗
PubMed1996

The introduction of mentorship to Project 2000 in Wales.

This study focused upon the introduction of mentors in the Common Foundation Programme (CFP) of Project 2000 (UKCC 1986) in Wales. It was commissioned by the Department of Health Research and Development Division on behalf of the Welsh Office Nursing Division. The study was policy oriented and its purpose was to inform future policy decision making through an analysis of the implementation of current policies for pre-registration education. The full title of our research project, 'The practitioner teacher: a study in the introduction of mentors in the pre-registration nurse education programme', implied that a clinically-based nurse practitioner with a designated teaching remit, fulfills a particular role (that of mentor) in the pre-registration nurse education programme. It was the nature, scope and impact of this mentor role during the initial implementation period of the CFP of Project 2000 in Wales to which this study addressed itself.

Curriculum↗
PubMed1996

The practitioner-teacher: a study in the introduction of mentors in the preregistration nurse education programme in Wales: Part 2.

This paper is the second of two which together report on a 2-year research project (Davies et al. 1994) investigating the implementation and impact of introducing mentors in the Common Foundation Programme of the new scheme for preregistration nurse education. The study was commissioned by the Department of Health and undertaken on an all-Wales basis. The first paper (Phillips et al. 1996) set the scene by discussing some underlying issues to policy reforms in nurse education, then placing the study setting within the context of a changing scenario in the National Health Service. The key techniques of data collection were then outlined (interviews, diary accounts, questionnaires, observations in clinical settings). This second paper will present the key themes to emerge from the data and suggest some important issues which arise from the findings of the research, worthy of further consideration and debate.

Education, Nursing↗
PubMed1996

The practitioner-teacher: a study in the introduction of mentors in the preregistration nurse education programme in Wales: Part 1.

This study focused on the introduction of mentors in the Common Foundation Programme of Project 2000 schemes of preregistration nurse education. The research, which was commissioned by the Department of Health Research and Development Division on behalf of the Welsh Office Nursing Division, began in February 1992 and was undertaken on an all-Wales basis. The completed report aims to provide policy makers with information relating to important issues which are central to the teaching and learning of nursing in clinical locations. This first paper discusses some background issues and gives a brief conceptual framework for considering policy reform, summarizes the research questions which emerged and describes the methods used to address them. The second paper (to appear in the next issue of the journal) will describe the key findings from the study and discuss some ensuing potential implications and considerations for all those involved in the preparation of future practitioners of nursing.

Clinical Competence↗
PubMed1996

Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces.

OBJECTIVE: Expiratory films are regarded as being superior to inspiratory films for pneumothorax detection, yet this has not been proved. In the current study, we compared inspiratory versus expiratory chest radiographs for pneumothorax detection. MATERIALS AND METHODS: Eighty-five paired inspiratory and expiratory radiographs with pneumothoraces and 93 pairs without pneumothoraces were randomly arranged and reviewed independently by three radiologists. A score of 1-5 was assigned for each hemithorax (5 = definite pneumothorax, 1 = definitely no pneumothorax). Results were compared for inspiration and expiration using receiver operating characteristic (ROC) analysis. RESULTS: The average area under the ROC curves for all readers was .973 for inspiration and .972 for expiration (nonsignificant). McNemar's test and an alpha level of .05 also yielded no significant difference in sensitivity and specificity. Four of the 85 cases were scored as definite pneumothorax on inspiration and as definitely not on expiration by all readers, and three of the 85 cases were scored as definite pneumothorax on expiration and as definitely not on inspiration. CONCLUSION: Inspiratory and expiratory upright films are equally sensitive for pneumothorax detection. Given the limitations of expiratory films, inspiratory films are recommended as the initial examination of choice for pneumothorax detection.

Female↗
PubMed1993

Prophylactic procainamide for prevention of atrial fibrillation after coronary artery bypass grafting: a prospective, double-blind, randomized, placebo-controlled pilot study.

OBJECTIVE: To evaluate the effect of prophylactic procainamide on the frequency of postoperative atrial fibrillation in patients undergoing myocardial revascularization. DESIGN: Prospective, randomized, double-blind, placebo-controlled pilot study. SETTING: Surgical intensive care unit and wards at a university hospital affiliate. PATIENTS: A total of 46 patients undergoing myocardial revascularization. INTERVENTIONS: Twenty-two patients received procainamide (procainamide group) and 24 patients received placebo (control group). Procainamide was administered to the procainamide group within 1 hr of the patient's arrival in the intensive care unit and consisted of an intravenous loading dose (12 mg/kg) followed by a maintenance dose (2 mg/min) of procainamide. The control group received a similar volume of placebo. When the patient was able to take oral medication, the study drug was administered orally in a weight-adjusted dosage. MEASUREMENTS: Electrocardiograms (EKGs) were continuously monitored. Procainamide and N-acetyl procainamide serum concentrations were measured, and the dosages in the procainamide group were adjusted by an independent observer. The study drug was continued for 5 days or until an event occurred that resulted in dismissal from the study. MAIN RESULTS: The procainamide group and control group had similar preoperative demographic descriptors and operative variables, except for the mean left ventricular ejection fraction, which was lower in the control group than in the procainamide group (60% vs. 68%, p = .03 [Wilcoxon rank-sum test]). There were no hospital deaths. The number of episodes of postoperative atrial fibrillation was significantly reduced in the procainamide group (5 episodes in 129 patient days at risk [3.9%/day at risk]) compared with the control group (17 episodes in 161 patient days at risk [10.6%/day at risk], p = .04 [Fisher's exact test]). Complication rates were similar in both groups. CONCLUSIONS: In a pilot trial, prophylactic procainamide reduced the number of episodes of atrial fibrillation in patients after coronary artery bypass grafting. Procainamide also decreased the number of patients who experienced postoperative atrial fibrillation. However, due to the small sample size, this latter difference was not statistically significant. Further studies are needed to confirm this encouraging trend.

Aged↗
PubMed1992

Planning, designing and developing an assessment tool for a 12-week accident emergency module as part of a pre-registration course: practical account.

The process of designing and developing an assessment tool for pre-registration students was governed by the need to assess students clinical competence during their 12-week exposure to the Accident and Emergency Department. It took the form of continuous assessment using a competency coding system ensuring criterion reference based assessment.

Curriculum↗
PubMedDate not supplied

Improving patient care and quality of life after laryngectomy/glossectomy.

Patients undergoing total laryngectomy/glossectomy are left without a voice at least temporarily in the early postoperative stage, since their larynx and/or tongue has been removed. Those patients rendered permanently speechless usually acquire a form of mechanical speech through electronic devices. However, the life-changing nature of this surgery should not be underrated as effectively these people have lost their normal voice. It can be argued that this patient group is also without a voice in a political sense - theirs seems to be a forgotten cancer, as other forms of cancer appear to attract greater attention for research priorities and funding. In some ways this research attempts to redress the balance through exploring the patient experience postoperatively, in particular the issues related to communication for this patient group. The results also highlight the emotional trauma experienced by patients and the mechanisms healthcare staff employ to support these patients. This research is multidisciplinary, involving patients and all those health workers that come into contact with them on the ward. The patient experience forms a major part of this article, allowing their stories to form much of the content. The results draw attention to deficiencies in service delivery that, as a direct result of this research, have been and are being addressed so that patients' care is improved and their quality of life is restored. Such change has been driven by patient comment such as: 'But then when you wake up after that operation that's the pits when you are laying there and you think "I'm dead". And then when you wake up properly that's the bit I always say you wish you were dead. That's when you wish you had died.'

Attitude to Health↗
PubMedDate not supplied

Teaching practical skills in colleges.

The author argues that the move towards Project 2000 students learning practical skills on the wards should be reversed and the old-style college practical room learning reintroduced. The benefits of this include better safety for patients, and less stressful learning for students.

Education, Nursing↗
PubMedDate not supplied

Preparing assessors for continuous assessment.

Student nurses are continuously assessed during their common foundation programme to establish their clinical competence. But, as this study shows, many practitioners feel ill-prepared to play the part of assessor; students also identify this inadequacy.

Accreditation↗
PubMedDate not supplied

Responsive assessment of clinical competence: Part 2.

AIM: To highlight the concerns that students and practitioners might have about the process of assessment of their nursing practice, and to suggest an alternative method. METHOD: Questionnaires were given to 300 student nurses and 155 nurse practitioners throughout a Common Foundation Programme and interviews were conducted with 70 students and 80 assessors from three colleges of nursing. RESULTS: Although students generally favoured structured assessment of their progress, they would like some flexibility. Students acknowledged stress caused by continuous assessment. Assessment of clinical competence was seen to be as important as academic assessment. It was felt that time should be allowed to discuss progress during and after practical experience. Students appreciated the need for continuous assessment, but favoured a change in the way assessment booklets were used. CONCLUSION: The author suggests a new concept of continuous assessment of students of nursing clinical competence. This new model is called responsive assessment, in which the assessment process focuses on the worth and merit of the care given by students to clients/patients, as well as set learning objectives.

Clinical Competence↗